Dialectics of Dementia Model
Discuss about the efficiency of massage therapy in reducing agitation in patients diagnosed with dementia.
A person-centered care approach comprises recognition of the individuality of a person, their personality, and their history; it tries to appreciate the world from the person’s perspective. It allows people to receive the support and care they require in a person-centered manner as well as enabling the people to be share in deciding the type of care to be offered (Adams and Grieder 2004). The Person-centered care approach enables the people to choose the care to be offered and have control over the choices they make. This assignment’s purpose is to assess a dementia patient and address one of the individual’s health care requirements to advance the quality of life of the person at the residential home as well as in the community (Stewart 2003). Mary is a 78-year-old lady who is a retired high school teacher and owns a glass shop; Mary is a single mother of two daughters. Mary has been lively and independent until in the last one year when she developed dementia, and now she lives in a personal care center. This assessment was conducted considering that Mary has her own needs and rights. Therefore, she needs to be listened to and respected (Adams and Grieder 2004). The history of Mary and how she is coming up with the dementia condition is discussed, the role of the intervention in improving Mary’s life is also discussed.
The Dialectics of Dementia model is applied in the structuring the assignment, which indicates how each component contributes to the process of dementia the model is summarized as; D=P+B+H+NI+S. Discussion of the interaction of these five elements allows a better understanding of dementia which is misinterpreted at the community level (Zhong 2014).
Personality: Mary has been a very social lady, and after her retirement as a high school teacher, she decided to run a small glass shop where she interacted with many people. However, due to dementia Mary’s character has been dramatically affected; she is unable to communicate effectively, she is agitated and feels withdrawn (Zeisel 2009).
Biography: Mary is usually a lively and independent person and even after her retirement she loved working in her shop where she interacted with various customers. The onset of dementia has dramatically affected her friends, children and even the customers (Brooker and Latham 2015).
Health status: Mary has is agitated which makes her restless and nervous a condition that causes her pace and wander around. It is noted that Mary wonders around during the late evening hours and sometime overnight. This condition is thought to be related to her loss of memory which results in her forgetting her place of residence. Greater focus is based on this matter in the discussion for the implementation of an appropriate intervention that is effective for improving Mary’s agitation problem, therefore, advancing her life’s quality (Mace and Rabins 2017).
Literature Review
Neurological impairment: Due to dementia Mary has become very agitated and withdrawn. Aggression is found to rise with more cognitive impairment; this explains Mary’s reduced ability to process and store information, and this influences Mary’s behavior and mood (Dean 2004).
Social psychology: being a single mother, Mary has been the breadwinner of her family, and this gave her purpose of working which in turn made her value her work and even after the retirement, she opened the shop which allowed her to interact with various people. After Mary was diagnosed with dementia, her daughters, relatives, and friends have been of great support. They have tried to avoid exposing Mary to the threats of malignant psychology such as outpacing, intimidation, mockery, disruption, and stigmatization as this would cause Mary to feel more withdrawn and agitated (Doyle 2012).
The investigation involves conducting a literature review to confirm the effectiveness of massage and touch therapy in reducing agitation in dementia patients. The massage and touch intervention is relation-centered, pro-active, evidence-based and practical. Therefore, Mary being a social and interactive person will significantly benefit from this intervention as it focuses mainly on human interaction (Reese Thiel and Cocker 2016). The massage intervention will impact positively on her life’s quality as she won’t feel isolated or withdrawn and there will be the improvement in the pattern of her sleeping. The research was carried out using the EMBASECINAHL and PubMed databases using the proper search terms.
The vital terms of the research
Behavior
Agitation
Dementia
Message and touch therapy
Agitation
A randomized research was conducted on 60 residential individuals with dementia, the objective of the study was to understand the effects of massage and touch therapy on the disorders related to dementia such as agitated behavior, depression, and anxiety. The second aim was to detect any adverse effects of dementia and offer recommendations for reducing agitation in the dementia patients (Kverno et al. 2009). 45 residential members participated in the massage therapy and the process involved hand massage and foot massage, the other 15 residents did not participate in the massage therapy, and they were mainly engaged in the pharmacological intervention process of dementia care within the residential home. The results indicated that both led to decrease in agitation, however, the individuals who participated in the massage therapy were even less agitated compared to those whose care was mainly pharmacological (Cohen-Mansfield 2001).
Further research was conducted to illustrate how the massage therapy helped reduce agitation in dementia patients. A study was conducted by the application of a tool of Validity Rating; this study involved 52 aged residents (of a mean age of about 76 years) 22 men and 30 women, and this study was conducted in two residential homes for dementia patients (Landreville et al. 2006). The participants, as confirmed by the residential home staff, were agitated and were also cognitively impaired. The intervention comprised of a 15minute gentle massage procedure of the hands, shoulders, and head. The results were evaluated using a scale that applied the five symptoms of behavior as per the minimum set of data; this includes; verbally offensive interactive symptoms, wandering, physically offensive interactive symptoms, resistance to maintenance and socially disruptive or inappropriate behavior. Cohen-Mansfield (2001) illustrates that the massage therapy significantly improves about 4 of the 5 outcomes that were examined, including verbally offensive interactive symptoms (0.59 vs 0.49, p=0.002), wandering (0.38 vs 0.16, p<0.001), resistance to maintenance (0.10 vs 0.09, p=0.022) and physically offensive interactive symptoms (0.82 vs 0.40, p<0.001). The study had its limitation as there was bias in the performance and selection process given the design of the study and the intervention’s nature.
Research Outcomes
The research outcome indicates that massage therapy has a significant impact on the reduction of agitation in the dementia patients. However, it is essential for the massage specialist to be trained ensure that the massage therapy provided is adequate. This is to ensure that the dementia patients such as Mary, gain adequate satisfaction in the care offered to them as compassionate and skilled human touch aids in easing psychosocial, physical, and emotional distress that results in interactive symptoms of dementia (Hansen Jørgensen and Ørtenblad 2006). Massage therapy is also a cognitive intervention to limit the consumption of medication. The next part of the assignment focuses on the requirements of Mary and the implementation of the massage therapy to reduce her agitation, knowing that massage therapy mainly focuses on human interaction Mary will significantly benefit from this intervention as she is an active and social woman (Gräsel Wiltfang and Kornhuber 2003).
Mary is offered an operative personal-centered care; this is important in ensuring that her needs are taken care of, her two daughters, the physical therapist and the multidisciplinary staff members of the residential home are part of the process of decision making. The discussion focused mainly on how Mary’s life could be improved and at this period Mary’s agitation was of great concern. The use of the personal-centered care outline helped the residential professional to understand how to converse with Mary (Brooker and Latham 2015) effectively. The elements of this framework are; the environment of the care, prerequisites, process outcomes and the process of personal-centered care. For the last one year during her stay at the residential home Mary has been yearning to interact with more people and her customers, use of non-verbal communication, as well as verbal communication through touch and massage, will make her feel safe and increase her satisfaction with the care offered as she will feel respected and listened to (Hansen Jørgensen and Ørtenblad 2006). The discussion involves the creation of a schedule for Mary ensuring that she has enough time for resting to reduce cases of anxiety, this timetable involves various physical exercise activities set by the care center. Mary is also allowed to contribute significantly to the decision of the care provided to avoid the cases of withdrawal. The most critical aspect is incorporating massage sessions in her timetable especially in the late afternoon hours, before the onset of her agitation, as this would help Mary relax.
Benefits of Massage Therapy
Mary was shown different schedules containing various activities, the facial expression and the body language portrayed by Mary when shown the timetable comprising of massage sessions indicated her acceptance of the massage therapy intervention. It was decided that Mary could be offered massages in her room where she could interact efficiently and effectively with the specialist (Adams and Grieder 2004). Two weeks before the intervention no massages or physical therapy was offered to Mary, during this time her behavior was monitored and documented. The following three weeks were filled with effective massage sessions, during this time, Mary’s behavior was also monitored and recorded. Mary’s daughters also needed to involved in the care process, they implemented an assessment tool (a notebook) in which they documented all the behavioral changes in Mary regarding the intervention. The nurses also documented all Mary’s changes in behavior in the medical records they also noted the non-verbal communication signs from Mary for effective conversation (Caspi 2010). The Cohen-Mansfield Inventory conducted the assessment of occurrence of agitation in Mary. The significance of observing Mary’s behavior, updating Mary’s behavioral documents and training the staff members on effective care provision was discussed. Promoting the care’s culture while eliminating all the malignant communal psychology was the significant aspect of the person-centered care which first focused on the requirements of Mary and not dementia itself.
Within the three weeks of the intervention process the multidisciplinary staff members, Mary’s daughters, and Mary stayed in her room to note the change in Mary’s behavior, this step was essential as it ensured close monitoring of Mary and documentation of vital behavioral aspects as well as the non-verbal communication signs of Mary. The staff provided maintenance of empathic and supportive care, worked according to Mary’s values and beliefs and listened to them. Results before implementation of massage therapy indicated that Mary required medication (such as olanzapine) to reduce her agitation (Kaplan 1996). However, this medication only brought about balance for a few hours before she became agitated again, her daughters were also concerned with too much provision of the medication as it made Mary very tired. The introduction of massage sessions broad a great reduction in Mary’s agitation, she became focused and relaxed, she would have a rest before cooperatively going for dinner. And on occasions, she became reluctant in carrying out some activities it was easier to persuade her to do so since she had become more relaxed and calm (Carpenito-Moyet 2009.).
Nurses noted that before massage therapy Mary experienced difficulties in expressing her self, especially when agitation heightened and this made her physically violent. However, through massage therapy, her sense of worthiness was encouraged, and interaction maintenance can be through a simple touch which will enable Mary to feel more relaxed and less anxious (Servan-Schreiber 2004). Interaction is also maintained through shared activities and a smile, and this is very significant for the dementia patients. During the massage session, the staff members noted a substantial improvement in the non-verbal communication signs of Mary as well as an improvement in her relaxation and decrease in her anxiety issues these aspects enabled Mary to sleep well, therefore, an increase in the quality of her life status. Implementation of this intervention enabled Mary to maintain meaningful eye contact during conversation, and this enabled her to have a choice for himself and increased independence (Kilstoff and Chenoweth 1998).
There was the performance of a CMAI before the implementation of massage therapy. This was done to indicate Mary’s common behavioral symptoms which involved physical aggressiveness as well as repeating of sentences and crying. However, some days after massage therapy implementation there was a decrease in Mary’s restlessness and anxiety. There was also increase in her relaxation and calmness as she felt control of her self with the reduction in the cases of verbal aggression (Caspi 2010).
These massage therapy has outlined the significance of non-pharmacological therapeutic approaches towards dementia care. The intervention re-enforces the need to train and educate the nurse workforce on the various types of dementia; this will enhance the nurses’ approaches and inter-personal skills in maintaining a physical environment that is non-distractive and calm. Implementation of the massage therapy intervention and close monitoring of the dementia patients is a technique that had not been adopted at the residential home before, however, this study has revealed its significance in fostering an effective person-centered care, therefore, the intended goal is to ensure the promotion of this achievement and promote the adaption of massage therapy in managing different types of dementia (Kales Gitlin and Lyketsos 2015). The regular documentation and assessment of the communication approaches of dementia patients are effective to every staff member of the residential care. Involving the family members in the process of decision making, for instance, the involvement of Mary’s daughters in decision making is essential in the person-centered care process (Eggenberger Heimerl and Bennett 2013). Collaborative working of the nurses with Mary’s family as well as Mary herself and trying to understand her in detail; her life before dementia, how she socialized with the other people and what she likes most has provided the nurses with adequate awareness, and even Mary has dementia she still has control over her life and this has boosted her confidence in the care provided to her. There is an emphasis on prevention of Mary’s exposure to the threats of malignant psychology such as intimidation as this will increase her agitation condition.
Conclusion
Massage therapy offered to Mary is a non-pharmacological approach which in this study has been essential in enhancing relaxation of dementia patients, and this has resulted in decrease in agitation in the patients who become less anxious and calm an aspect that indicates improved quality of life (Hansen, Jørgensen and Ørtenblad 2006). The intervention has lowered the use of medications such as olanzapine which might have side effects on the patient such as tiredness and drowsiness. The constant monitoring ensures useful update to the nurses for the sufficient time to offer massages and other relevant requirements needed by Mary, and this is an indication that Mary’s needs are listened to and respected, and these are the crucial factors in taking care of dementia patients. This intervention assisted in advancing the self-confidence of Mary and the quality of her life, this is noted by the decrease in her aggressive behavior as well as the decrease in her withdrawal behavior, and therefore, her social characteristics are increased after the implementation of the intervention.
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